Breast elastography: the technical process and its applications.

Area of Science:

• Medical Imaging
• Diagnostic Ultrasound
• Biomedical Engineering

Background:

• Breast elastography is increasingly utilized to improve the characterization of breast lesions.
• Studies indicate elastography enhances the specificity of B-mode ultrasound.
• Two primary elastography modes exist: free-hand elastography and shear wave elastography.

Purpose of the Study:

• To review the application and findings of breast elastography in lesion characterization.
• To compare the methodologies and diagnostic utility of free-hand and shear wave elastography.
• To discuss the role of elastography in managing indeterminate breast lesions.

Main Methods:

• Description of free-hand elastography, including mechanical wave induction and elastogram display (color map, size/elasticity ratio).
• Explanation of shear wave elastography (SWE) and Acoustic Radiation Force Impulse (ARFI) methods.
• Presentation of quantitative diagnostic criteria: >80kPa (SWE) or >2m/s (ARFI) as suspicious.

Main Results:

• Elastography improves specificity when used with B-mode ultrasound.
• Shear wave elastography is less operator-dependent and provides quantitative measurements.
• Potential for false negatives in soft cancers and false positives in stiff benign lesions exists.

Conclusions:

• Elastography serves as a valuable complementary tool for BI-RADS 3, BI-RADS 4a, or cystic breast lesions.
• It aids in differentiating indeterminate lesions but does not replace biopsy for suspicious findings.
• Understanding limitations like false negatives/positives is crucial for accurate interpretation.